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Automated testing combined with automated retraining to improve CPR skill level in emergency nurses

Authors:
Learning and teaching in clinical practice
Automated testing combined with automated retraining to improve
CPR skill level in emergency nurses
Nicolas Mpotos
a
,
c
,
f
,
*
, Karel Decaluwe
b
,
1
, Vincent Van Belleghem
b
,
2
, Nick Cleymans
c
,
3
,
Joris Raemaekers
c
,
4
, Anselme Derese
c
,
5
, Bram De Wever
d
,
6
, Martin Valcke
d
,
7
,
Koenraad G. Monsieurs
c
,
e
,
f
,
8
a
Emergency Department, Ghent University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium
b
Emergency Department, AZ Groeninge, Loofstraat 43, B-8500 Kortrijk, Belgium
c
Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, B-9000 Ghent, Belgium
d
Department of Educational Studies, Ghent University, H. Dunantlaan 2, B-9000 Ghent, Belgium
e
Emergency Department, Antwerp University Hospital, Wilrijkstraat 10, B-2650 Edegem, Belgium
f
Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, B-2610 Wilrijk, Belgium
article info
Article history:
Accepted 19 November 2014
Keywords:
Automated testing
Basic life support
CPR
Nurses
Self-learning
abstract
Objectives: To investigate the effect of automated testing and retraining on the cardiopulmonary
resuscitation (CPR) competency level of emergency nurses.
Methods: A software program was developed allowing automated testing followed by computer exer-
cises based on the Resusci Anne Skills Station(Laerdal, Norway). Using this system, the CPR compe-
tencies of 43 emergency nurses (mean age 37 years, SD 11, 53% female) were assessed. Nurses passed the
test if they achieved a combined score consisting of 70% compressions with depth 50 mm and 70%
compressions with complete release (<5 mm) and a mean compression rate between 100 and 120/min
and 70% bag-valve-mask ventilations between 400 and 1000 ml. Nurses failing the test received
automated feedback and feedforward on how to improve. They could then either practise with computer
exercises or take the test again without additional practise. Nurses were expected to demonstrate
competency within two months and they were retested 10 months after baseline.
Results: At baseline 35/43 nurses failed the test. Seven of them did not attempt further testing/practise
and 7 others did not continue until competency, resulting in 14/43 not competent nurses by the end of
the training period. After ten months 39 nurses were retested. Twenty-four nurses failed with as most
common reason incomplete release.
Conclusion: Automated testing with feedback was effective in detecting nurses needing CPR retraining.
Automated training and retesting improved skills to a predened pass level. Since not all nurses trained
until success, achieving CPR competence remains an important individual and institutional motivational
challenge. Ten months after baseline the combined score showed important decay, highlighting the need
for frequent assessments.
©2014 Elsevier Ltd. All rights reserved.
*Corresponding author. Emergency Department, Ghent University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium. Tel.: þ32 497 301079; fax: þ32 9 3324980.
E-mail addresses: nicolas.mpotos@ugent.be (N. Mpotos), karel.decaluwe@azgroeninge.be (K. Decaluwe), Vincent.vanbelleghem@azgroeninge.be (V. Van Belleghem), nick.
cleymans@ugent.be (N. Cleymans), joris.raemaekers@ugent.be (J. Raemaekers), anselme.derese@ugent.be (A. Derese), bram.dewever@ugent.be (B. De Wever), martin.
valcke@ugent.be (M. Valcke), koen.monsieurs@ugent.be (K.G. Monsieurs).
1
Tel.: þ32 477 560971.
2
Tel.: þ32 476 484297.
3
Tel.: þ32 474 303075.
4
Tel.: þ32 487 437235.
5
Tel.: þ32 471 850063.
6
Tel.: þ32 496 950984.
7
Tel.: þ32 476 999812.
8
Tel.: þ32 478 602792.
Contents lists available at ScienceDirect
Nurse Education in Practice
journal homepage: www.elsevier.com/nepr
http://dx.doi.org/10.1016/j.nepr.2014.11.012
1471-5953/©2014 Elsevier Ltd. All rights reserved.
Nurse Education in Practice xxx (2014) 1e6
Please cite this article in press as: Mpotos, N., et al., Automated testing combined with automated retraining to improve CPR skill level in
emergency nurses, Nurse Education in Practice (2014), http://dx.doi.org/10.1016/j.nepr.2014.11.012
Introduction
Emergency nurses are often involved in the management of
cardiac arrest. Lack of cardiopulmonary resuscitation (CPR) skills of
nurses and physicians contributes to poor outcome of cardiac arrest
victims (Perkins et al., 2008; Passali et al., 2011; Xanthos et al.,
2012; Smith et al., 2008; Seethala et al., 2010). Despite CPR
training efforts, acquisition of compression and ventilation skills
are often poor and they decay rapidly (Chamberlain et al., 2002;
Jones et al., 2007). Nurses have a professional responsibility to
remain competent in CPR through regular updates. The use of
frequent assessments may identify those individuals requiring
additional training (Andresen et al., 2008; Castle et al., 2007; Wik
et al., 2005; Christenson et al., 2007; Niles et al., 2009). Although
recommended by the European Resuscitation Council (ERC) and by
the American Heart Association (AHA) systematic testing of
healthcare providers after a course or after a predened interval is
still not current practice. According to Dwyer and Moser Williams
(2002) CPR training strategies that encourage nurses to update
CPR skills should be developed. The purpose of the current study
was to investigate the effect of automated testing combined with
automated retraining on the CPR competency level of emergency
nurses.
Background
As nurses are often the rst professionals to encounter a person
in cardiac arrest, the effectiveness of their actions has a signicant
effect on survival (Nyman and Sihvonen, 2000; Madden, 2006). It is
therefore essential that effective instructional strategies are
implemented to ensure high-quality resuscitation performance.
Some investigators (Lynch et al., 2007) stated that instructors
judgement alone is not sufcient to determine CPR competence. As
an alternative to assessment by instructors we previously devel-
oped an automated testing station enabling formative assessment
and certication procedures in a time-efcient manner without
instructor involvement (Mpotos et al., 2012). Automated assess-
ment also offers the possibility to provide an immediate and ac-
curate test result (¼feedback) together with information on how to
further improve (¼feedforward), which according to Hattie (2009)
is the most powerful tool for learning improvement. This techno-
logical advance can reduce recertication time and allow focused
individualised retraining.
CPR skill performance is dened by the international guidelines
for resuscitation (American Heart Association and European
Resuscitation Council). These guidelines recommend that training
should be tailored to the needs of different types of learners and
learning styles to ensure adequate acquisition and retention of
skills (Soar et al., 2010). The AHA guidelines (2010) emphasize the
importance of simplication of CPR instruction to focus on
competence in the small set of skills most strongly associated with
the victim's survival. Delivery of chest compression is the CPR skill
most likely to improve survival and therefore a method for valid
determination of rescuers' competence to perform this skill is
important (Lynch et al., 2007). As such, educational interventions
need to be evaluated to ensure that they achieve the desired
educational outcomes. According to M
akinen et al. (2007) various
methods to assess CPR skills are currently used, often with meth-
odological shortcomings. It has been stated (Wass et al., 2001) that
clinical competence should be assessed against a predened pass
level. Since no specic CPR related research is available to propose a
benchmark, we built on general principles as derived from Mastery
Learning research indicating that a high attainment level has to be
pursued before moving to the next learning goal and that formative
assessment should be adopted to give immediate feedback. In this
context, Hattie (2009) reported that Mastery Learning approaches
result in high effect sizes (ES) when considering the impact on
learning performance (ES ¼0.58). Building on this knowledge a
combined assessment score using a 70% cut-off was established by
our research group (Mpotos et al., 2013) allowing more compre-
hensive reporting of overall CPR quality than reporting each skill
separately. However, the relative importance of each individual
skill and the exact relationship between skill level after training
and real-life CPR performance are currently unknown.
Research design
The Ethics Committee of Groeninge General Hospital (Kortrijk,
Belgium) approved the study. From March 2012 until January 2013,
43 of the 51 emergency nurses gave informed consent and partic-
ipated in the study. Eight months prior to the study all nurses had
been trained with the commercially available Resusci Anne Skills
Station(Laerdal, Norway) computer exercises.
A self-learning station equipped with a manikin linked to a
computer was available in a small room secured with a numeric
lock, accessible 24 h a day and seven days a week (Mpotos et al.,
2011a, 2011b). For the purpose of the study, a software program
was developed to allow automated testing with feedback/feed-
forward (Ghent University, Belgium) combined with automated
self-training sessions on a CPR manikin (Resusci Anne Skills Sta-
tion, Laerdal, Norway). As such we created short self-learning
sessions where the nurses could repetitively test or test-
practice-test until they achieved the required predened pass
level. Practising and testing was done on a full size torso disposed
on the oor and using a bag-valve-mask device while performance
of chest compression depth, complete release, rate and ventilation
volume was registered. Each emergency nurse was invited to
perform a rst automated test (resuscitate a victim of cardiac ar-
rest during 2 min) in order to establish baseline CPR skill level (T0;
basic life support). To pass the test, nurses had to achieve a 70%
combined assessment score consisting of 70% compressions with
depth 50 mm and 70% compressions with complete release
(<5 mm) and a mean compression rate between 100 and 120/min
and 70% ventilations with a volume between 400 and 1000 ml.
After each test an instant result was provided on screen (feed-
back). Nurses who failed the test were also informed about how to
improve their individual skills (feedforward). They could then
choose to perform a new test or rst practice. Both could take
place immediately or at a different moment, in which case the
feedback and feedforward of the last test was recalled at the
beginning of the new session (¼feedup). Practice was done using
full CPR computer exercises (30 ventilations to two compressions)
with concurrent voice feedback (Resusci Anne Skills Stationwith
limits set according to the ERC 2010 guidelines) and followed by a
new 2 min test.
All nurses were asked to achieve a pass score on the test within a
two months period (T1).
Ten months after the baseline measurement each nurse was
invited to perform a new test (T2). Before performing the new test
the result of the last performed test was displayed on screen. Not
competent nurses also received feedforward on how to improve.
Participants were sent up to three reminders in order to encourage
them to participate in the retest. The participants ow chart is
shown in Fig. 1.
Performances at baseline (T0), following training (T1), and after
ten months (T2) were compared. Proportions are reported as
counts and percentages. Condence intervals (CI) are reported for
the differences in proportions between T0eT1 and T1eT2.
N. Mpotos et al. / Nurse Education in Practice xxx (2014) 1e62
Please cite this article in press as: Mpotos, N., et al., Automated testing combined with automated retraining to improve CPR skill level in
emergency nurses, Nurse Education in Practice (2014), http://dx.doi.org/10.1016/j.nepr.2014.11.012
Results
Forty-three emergency nurses participated in the study. Mean
age was 37 years (SD 11) and 53% were female. At baseline 35/43
nurses did not achieve the predened pass level of which seven did
not attempt any further training (repeated automated testing or
practice with computer exercises). Seven others started to train but
did not continue until reaching a pass, resulting in 14/43 nurses not
achieving the pass level at the end of the two months period (Fig. 1).
Eleven nurses skipped the Skills Stationcomputer exercises and
succeeded by only performing repetitive tests with feedback. The
mean time to achieve success was 13 min (SD 15).
Ten months after baseline 39 nurses were retested (4 nurses
dropped out: 1 had retired,1 had left the hospital and 2 for medical
reasons) and 24 did not pass the test (T2). Six of the 14 nurses not
achieving a pass at T1 (two had attempted training but four had
only performed a baseline test) passed after ten months (Fig. 1).
The proportion of successful nurses improved for all outcome
measures after training (T1; Fig. 2) and was maintained or even
improved after ten months (T2) except for complete release (Fig. 2).
The reason for failing the test at T0 was due to failure of one skill
in 22/35 (63%) nurses, two skills in 10/35 (29%), three skills in 2/35
(6%). Only one nurse failed on all four skills. After ten months (T2)
the proportions were respectively 20/24 (83%), 3/24 (12.5%), 1/24
(4%) and 0/24 (0%). The skills most likely to fail at T0 were mean
compression rate (16/35), ventilation volume (14/35) and
compression depth (13/35). After ten months most failures were
due to incomplete release (12/24) and inadequate mean compres-
sion rate (8/24).
Complete release appeared to be the skill with the most decay
(15%) whereas the other skills were maintained or even improved.
Proportions of successful nurses at baseline (T0), at the end of
training (T1) and after ten months (T2) are reported for the com-
bined assessment score and for each individual skill (Table 1).
Discussion
At baseline (T0) the proportion of nurses achieving a pass level
was as low as 19%. This conrms the ndings of other investigators
(Chamberlain et al., 2002; Jones et al., 2007) reporting rapid skill
decay. The very poor baseline level in our study might also be
attributed to the fact that, although the majority of nurses achieved
70% success for many individual skills, the combined score required
a minimum of 70% success on each of the four CPR skill
components.
Within two months, additional practice and/or formative testing
in our self-learning environment allowed most nurses to improve
their skill level to the predened level (Table 1 and Fig. 2). The mean
time to achieve success was 13 min, which can be explained by the
fact that almost half of the nurses only performed repetitive
formative tests and skipped the additional practice. Kromann and
colleagues (2009a; 2009b) reported that testing on its own has a
learning effect. But according to several investigators the most
powerful tool for learning improvement consist in delivering
individualised feedback and feedforward after a test (Dine et al.,
2004; Hattie, 2009; Seethala et al., 2010; Andriessen et al., 2012).
That could explain the skills improvement in nurses who did not
practice with the Skills Stationcomputer exercises.
Fig. 1. Study design.
N. Mpotos et al. / Nurse Education in Practice xxx (2014) 1e63
Please cite this article in press as: Mpotos, N., et al., Automated testing combined with automated retraining to improve CPR skill level in
emergency nurses, Nurse Education in Practice (2014), http://dx.doi.org/10.1016/j.nepr.2014.11.012
After ten months 28% of the successful nurses at T1 did not
achieve the combined assessment score. Although the proportion
of successful nurses was better when compared to the baseline test
(39% vs. 19%) it still reects poor overall group performance, con-
rming once again that individual skills rapidly decrease over time
and should be assessed more frequently. With regard to the decay
in complete release after ten months, we hypothesize that this
might be explained by an improved compression depth causing
more incomplete chest recoil. In relation to the participants who
achieved success at T3 but were unsuccessful at T2, we hypothesize
that clinical resuscitation experience that may have taken place in
the period before retesting might have had a learning effect on their
skills.
With regard to the fact that not every participant trained until
prociency, Nyman and Sihvonen (2000) reported that nurses can
be poor at self-assessment of their resuscitation skills and therefore
Fig. 2. Cumulative proportion of participants achieving a minimal percentage of compressions with depth 5 cm (a), with complete release <5 mm (b), ventilations with volume
400e1000 ml (c), a threshold for a combined assessment score (d).
Table 1
Proportions of success at baseline (T0; n¼43), at the end of the training (T1; n¼43) and after 10 months (T2; n¼39).
Baseline (T0) End of training (T1) After 10 months (T2)
Number of
participants n/N (%)
Number of
participants n/N (%)
Difference in proportion
(T0-T1) % [95% CI]
Number of
participants n/N (%)
Difference in proportion
(T1eT2) % [95% CI]
70% Combined score
a
8/43 (19) 29/43 (67) 48% [0.33e0.63] 15/39 (39) 28% [0.14e0.42]
70% Compressions 50 mm 30/43 (70) 31/43 (72) 2% [0.02 0.06] 34/39 (87) 15% [0.04e0.26]
70% Compressions with
complete release <5mm
34/43 (79) 36/43 (84) 5% [ 0.02 0.12] 27/39 (69) 15% [0.04e0.26]
Compression rate 100e120/min 27/43 (63) 35/43 (81) 18% [0.07e0.30] 31/39 (80) 1% [0.02 0.04]
70% Ventilations between
400 and 1000 ml
29/43 (67) 32/43 (74) 7% [0.01 0.15] 35/39 (90) 16% [0.05e0.28]
a
70% combined score: 70% of all compressions 50 mm and 70% of all compressions with complete release and compression rate between 100 and 120/min and 70% of
all ventilations between 400 and 1000 ml.
N. Mpotos et al. / Nurse Education in Practice xxx (2014) 1e64
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emergency nurses, Nurse Education in Practice (2014), http://dx.doi.org/10.1016/j.nepr.2014.11.012
may be less likely to seek further training/update. Davies and Gould
(2000) highlighted that annual updates are insufcient in main-
taining competence and in a review on competency assessment
Allen et al. (2013) suggested testing at least once or twice a year.
This is in line with the ndings of our research indicating that decay
is already noticed after ten months. Achieving or maintaining high
quality resuscitation skills is possible for every participant but
constitutes a major individual and institutional motivational chal-
lenge. The learning of practical skills is not only inuenced by the
retention of factual knowledge and the performance of the skill
itself but also by the attitude of the learner (Gentle, 1972; Jonassen
and Grabowski, 1993). As highlighted by many authors
(Darkenwald and Merriam, 1982; Conklin, 1995; Dwyer and Mosel
Williams, 2002; Hopstock, 2008), the motivation to learn is
essential if education is to be successful. Facilitating the process of
learning by increasing the motivation of candidates is a complex
procedure, but is crucial to the education of adults. By applying
Knowles' (2005) principles of adult learning we can inuence
motivation in many ways, by attention to the learning environment,
by providing material appropriate to the candidate's needs, and by
ensuring that instruction is carried out to the highest standards.
Implications for nurses
Our data demonstrate the feasibility to identify nurses needing
retraining by means of an automated test using a 70% combined
skills assessment score. A self-learning environment using a
formative testing strategy building on adult learning principles can
target training to the needs of each learner, allowing multiple
practice attempts. It also provides the opportunity for objective
feedback on performance together with feedforward on how to
improve, allowing learners to evaluate their CPR performance in
detail. Furthermore, the automated formative assessment proce-
dure also provides a unique opportunity for bench marking.
Nurse educators and emergency nurses should reinforce the
essential role of nurses in the management of cardiac arrest, and
without this understanding nurses might not be motivated to
participate in CPR education (Dwyer and Moser Williams, 2002). By
additionally stressing the moral and legal responsibility of every
individual to take action, this may increase motivation to achieve
prociency and to retrain skills (Hopstock, 2008).
Limitations
No details regarding the efcacy of the CPR training prior to the
study were available. Furthermore, the nurses were not familiar
with automated assessment which may have negatively inuenced
the baseline results.
Conclusions
Automated testing with feedback was effective in detecting
nurses needing CPR retraining. Additional practice and/or retesting
improved skills to a predened pass level. Since not all nurses
trained until competency, achieving CPR competence remains an
important individual and institutional motivational challenge. Ten
months after baseline the combined score showed important
decay, highlighting the need for more frequent assessments.
Conict of interest
We received an unrestricted grant from the Laerdal Foundation.
Laerdal Medical (Stavanger, Norway) provided the manikin and the
Resusci Anne Skills Stationlicenses for the study. Laerdal has
taken no part in neither designing the study, developing the soft-
ware, analysing data nor writing of the manuscript.
Acknowledgements
We are grateful to the management of Groeninge General Hos-
pital (Kortrijk, Belgium) and to all the emergency nurses who
participated in the study. We are especially grateful to Bram
Gadeyne for the software development.
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emergency nurses, Nurse Education in Practice (2014), http://dx.doi.org/10.1016/j.nepr.2014.11.012
... CPR training was provided with an automated CPR self-learning station (CPRTEST®, Pinga Group, Belgium) using a repetitive formative test strategy to minimize performance bias (Mpotos et al., 2012, Mpotos et al., 2013, Mpotos et al., 2015. Participants were not familiar with automated self-learning and assessment of CPR skills. ...
... In order to succeed training, participants had to achieve a predefined combined score of ≥70% consisting of ≥70% chest compressions with depth 50-60 mm and ≥70% chest compressions with complete release (≤5mm) and a mean compression rate of 100-120 bpm and ≥70% ventilations with visible chest rise (volume 200-800 ml) during a twominute formative test (Mpotos et al., 2012, Mpotos et al., 2013, Mpotos et al., 2015. Past research recommended clinical competence to be assured by passing a predefined competence level (Wass et al., 2001). ...
... Past research recommended clinical competence to be assured by passing a predefined competence level (Wass et al., 2001). The threshold of 70% was in accordance with previous research (Mpotos et al., 2013, Mpotos et al., 2015. A two-minute period was chosen to minimise fatigue . ...
Introduction Chest compression quality during in-hospital resuscitation is often suboptimal on a soft surface. Scientific evidence regarding the effectiveness of a backboard is scarce. This single-blinded manikin study evaluated the effect of a backboard on compression depth, rate and chest recoil performed by nurses. Sex, BMI, age and clinical department were considered as potential predictors. Methods Using self-learning, nurses were retrained to achieve a minimal combined compression score at baseline. This combined score consisted of ≥70% compressions with depth 50–60 mm, ≥70% compressions with complete release (≤5mm) and a mean compression rate of 100–120 bpm. Subsequently, nurses were allocated to a backboard or control group and performed a two-minute cardiopulmonary resuscitation test. The main outcome measure was the difference in proportion of participants achieving a combined compression score of ≥70%. Results In total 278 nurses were retrained, 158 nurses dropped out and 120 were allocated to the backboard (n = 61) or control group (n = 59). The proportion of participants achieving a combined compression score of ≥70% was not significantly different (p = 0.475) and suboptimal in both groups: backboard group 47.5% (backboard) versus 41.0% (control). Older age (≥51 years) was associated with a lower probability of achieving a combined compression score >70% [OR = 0.133; 95% confidence interval (CI), 0.037–0.479; p = 0.002]. Conclusion Using a backboard did not significantly improve compression quality in our study. Important decay of compression skills was observed in both groups, highlighting the importance of frequent retraining, particularly in some age groups.
... Os enfermeiros são quem na maior parte das vezes se depara com situações de PCR, nomeadamente os enfermeiros do serviço de urgência (SU), e a sobrevivência dos doentes depende em grande medida da efetividade da sua intervenção (4)(5)(6) . Apenas com a realização de manobras adequadas e de elevada qualidade, é possível garantir uma maior pro-babilidade de sobrevivência dos doentes, como documentam vários autores ao afirmar que uma performance deste nível torna possível duplicar e até mesmo quadruplicar a sobrevivência das vítimas de PCR (1,4,7) . ...
... Ao observar o gráfico 1, percebe-se que a maioria dos enfermeiros da amostra apresentou uma performance inferior a 80% e apenas 26,7% uma performance superior a 90%. Performances semelhantes ou inferiores foram documentadas por vários autores, demonstrando os seus estudos que os enfermeiros e os restantes profissionais de saúde se debatem com a dificuldade de reter competências psicomotoras de reanimação (1,4,6,(18)(19)(20) . Um dos autores afirma que apenas 19% dos enfermeiros foram classificados como aprovados num exercício de simulação (6) . ...
... Performances semelhantes ou inferiores foram documentadas por vários autores, demonstrando os seus estudos que os enfermeiros e os restantes profissionais de saúde se debatem com a dificuldade de reter competências psicomotoras de reanimação (1,4,6,(18)(19)(20) . Um dos autores afirma que apenas 19% dos enfermeiros foram classificados como aprovados num exercício de simulação (6) . ...
... Os enfermeiros são quem na maior parte das vezes se depara com situações de PCR, nomeadamente os enfermeiros do serviço de urgência (SU), e a sobrevivência dos doentes depende em grande medida da efetividade da sua intervenção (4)(5)(6) . Apenas com a realização de manobras adequadas e de elevada qualidade, é possível garantir uma maior pro-babilidade de sobrevivência dos doentes, como documentam vários autores ao afirmar que uma performance deste nível torna possível duplicar e até mesmo quadruplicar a sobrevivência das vítimas de PCR (1,4,7) . ...
... Ao observar o gráfico 1, percebe-se que a maioria dos enfermeiros da amostra apresentou uma performance inferior a 80% e apenas 26,7% uma performance superior a 90%. Performances semelhantes ou inferiores foram documentadas por vários autores, demonstrando os seus estudos que os enfermeiros e os restantes profissionais de saúde se debatem com a dificuldade de reter competências psicomotoras de reanimação (1,4,6,(18)(19)(20) . Um dos autores afirma que apenas 19% dos enfermeiros foram classificados como aprovados num exercício de simulação (6) . ...
... Performances semelhantes ou inferiores foram documentadas por vários autores, demonstrando os seus estudos que os enfermeiros e os restantes profissionais de saúde se debatem com a dificuldade de reter competências psicomotoras de reanimação (1,4,6,(18)(19)(20) . Um dos autores afirma que apenas 19% dos enfermeiros foram classificados como aprovados num exercício de simulação (6) . ...
Article
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Sudden cardiac arrest is one of the leading causes of death in developed countries. Nurses are the ones who most often encounter these situations, and the safety and survival of of critically ill patients depends on the effectiveness of their intervention. It was intended to evaluate the performance of the emergency nurses in basic life support, before and after a theoretical and practical training session on this topic, and to identify some of the determinants of their performance. An exploratory-descriptive study was developed during five weeks, in which 10 training sessions were performed using simulation, involving 30 nurses. The performance verified in the first simulation was 77.5% and in the second 94.3%. In the group of nurses that performed best in the first simulation, 93% had previous training in basic life support, and 31% of them had completed training after 2015. In the group with the worst performance, only 63% had training in this area and none of the nurses had trained after 2015.
... [4] Advanced life support (ALS) knowledge and skills decay by 6 months to 1 year after training and the skills decay faster than knowledge. [6,21,22,23] Allen et al. [21] also reported that there was no correlation between theoretical knowledge and resuscitation performance. However, in this study, a significant correlation was seen between resuscitation knowledge and performance in phase one. ...
... CPR competence remains an important individual and institutional motivational challenge. [23] The certified nurses' mean CPR knowledge, though higher than the noncertified nurses, did not show a statistically significant increase, indicating the need for periodic and more frequent refresher training for sustained improvement in knowledge and skill. Delivering ALS education more frequently than annually would increase skills maintenance and lessen skill decays. ...
Article
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Context: Cardiopulmonary resuscitation (CPR) and emergency cardiovascular care guidelines are periodically renewed and published by the American Heart Association. Formal training programs are conducted based on these guidelines. Despite widespread training CPR is often poorly performed. Hospital educators spend a significant amount of time and money in training health professionals and maintaining basic life support (BLS) and advanced cardiac life support (ACLS) skills among them. However, very little data are available in the literature highlighting the long-term impact of these training. Aims: To evaluate the impact of formal certified CPR training program on the knowledge and skill of CPR among nurses, to identify self-reported outcomes of attempted CPR and training needs of nurses. Setting and design: Tertiary care hospital, Prospective, repeated-measures design. Subjects and methods: A series of certified BLS and ACLS training programs were conducted during 2010 and 2011. Written and practical performance tests were done. Final testing was undertaken 3-4 years after training. The sample included all available, willing CPR certified nurses and experience matched CPR noncertified nurses. Statistical analysis used: SPSS for Windows version 21.0. Results: The majority of the 206 nurses (93 CPR certified and 113 noncertified) were females. There was a statistically significant increase in mean knowledge level and overall performance before and after the formal certified CPR training program (P = 0.000). However, the mean knowledge scores were equivalent among the CPR certified and noncertified nurses, although the certified nurses scored a higher mean score (P = 0.140). Conclusions: Formal certified CPR training program increases CPR knowledge and skill. However, significant long-term effects could not be found. There is a need for regular and periodic recertification.
... Nursing educators played an important role in helping students pull through challenges caused by memorable patients' death experience and promoting their growth. Similarly, previous studies evidenced that supports from clinical staff help to develop the ability of nursing students to deal with death [13,28], and improve students' professional growth [29,30]. Paying more attention to death education in clinical settings could be an ideal way to improve students' skills and attitudes [28]. ...
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Aim To describe the experiences of student nurses in confronting the death of their patients, and to understand how they cope with these events and to what extent there are unmet needs that can be addressed in their trainings. Methods Semi-structured interview method was used to collect data from Chinese nursing students and then Colaizzi’s seven-step analysis method was applied to identify recurrent themes in their responses to patient deaths. We listened the tape repeatedly combined with observations of their non-verbal behaviors, then transcribed them with emotional resonance, and entered them into Nvivo. After that, we extracted repeated and significant statements from the transcriptions, coded, then clustered codes into sub-themes and themes which were identified by the comparation with transcriptions and re-confirmation with our participants. Results After confirmation from the interviewees, five themes emerged: emotional experience, challenge, growth, coping and support.
... CPR skill stations have been shown to be effective in both initial skill acquisition and could help identify health professionals in need of retraining. 22,23 Short refresher courses in between regular CPR courses have shown to improve skill retention for up to one year, 24 and CPR skill stations could offer an effective means of retaining skill competence by means of short refresher training for a few minutes monthly or every 2-3 months. 25,26 Even though the level of evidence is low, it is recommended that CPR training is part of an integrated program focusing on CPR quality, feedback, debriefing and data surveillance. ...
Article
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Introduction Intrahospital cardiac arrest has a steep mortality and high-quality cardiopulmonary resuscitation (CPR) is essential for favourable outcome. Instructor led (IL) CPR training is resource demanding and instructor free, feedback providing CPR skill stations (SS) could provide a means to enable the needed frequent retraining. The main objective of this study was to test the hypothesis that there was no difference between IL and SS training. Methods A total of 129 hospital nurses were randomised to CPR retraining in three groups; skill station with retraining at 2 months (SS-R), skill station without retraining (SS) and instructor led training (IL). Participants were tested at baseline, 2 and 8 months. The skill station groups were combined (c-SS) for analysis at baseline and 2 months when comparing to IL. Results Baseline characteristics for the three groups differed significantly, however c-SS and IL groups performed equally at baseline and testing at 2 months. At 8 months the SS group performed 71% correct ventilations compared to 54% in the IL group (p = 0.04), but CPR quality was otherwise equal. Longitudinal analysis showed SS-R performed 3.4 mm deeper compressions at final evaluation compared to baseline (p = 0.02) and 2.8 mm deeper compared to 2-month test (p = 0.02). No effects of retraining at 2 months could be detected at final comparison of SS-R and SS groups. Conclusion CPR training using a skill station led to equal performance at 2 and 8 months compared to instructor led training. Feedback-providing skill stations could be a feasible tool for required frequent retraining.
... [16][17][18][19][20][21][22][23] However, without repetition, CPR performance degrades over time. [21][22][23][24][25][26][27] The AHA's Resuscitation Quality Improvement (RQI) program provides spaced training 21 in the form of short duration CPR training and skill assessment at least every 3 months. 28 While more frequent practice improves CPR performance, there is little evidence to support the 3-month interval as the optimal frequency of these training sessions. ...
Article
Aim: Spaced training programs employ short, frequent CPR training sessions to improve provider skills. The optimum training frequency for CPR skill acquisition and retention has not been determined. We aimed to determine the training interval associated with the highest quality CPR performance at one year. Methods: Participants were randomized to 1-month, 3-month, 6-month, and 12-month CPR training intervals over the course of a 12-month study period. Practice sessions included repeated two-minute CPR practice sessions with visual feedback and verbal coaching until Excellent CPR was achieved, to a maximum of three attempts. Excellent CPR was defined as a two-minute CPR session with ≥90% of compressions with a depth of 50-60 millimeters, a rate of 100-120 per minute, and with complete chest recoil. CPR performance was assessed in all groups at 12 months. The primary outcome was the proportion of participants able to perform Excellent CPR in each group. Results: A total of 167 participants were included in the analysis. Baseline assessment showed no difference in CPR performance (p = 0.38). Participants who were trained monthly had a significantly higher proportion of Excellent CPR performance (58%) than those in all other groups (26% in the 3-month group, p = 0.008; 21% in the 6-month group, p = 0.002; and 15% in the 12-month group, p < 0.001). Conclusion: Short-duration, distributed CPR training on a manikin with real-time visual feedback is effective in improving CPR performance, with monthly training more effective than training every 3, 6, or 12 months.
... proportion of compressions with adequate depth or effective compression ratio) [33e36]. Multiple repetitive formative tests were able to train people to a predefined success level and even although there was a small decay in skills after 5 months, compression depth was still adequate in 80% of the participants [12,37]. Other authors also described the efficiency of rapid cycle deliberate practice or training based on mastery learning principles [38,39]. ...
Article
The link between effective basic life support (BLS) and survival following cardiac arrest is well known. Nurses are often first responders at in- hospital cardiac arrests and receive annual BLS training to ensure they have the adequate skills, and student nurses are taught this in preparation for their clinical practice. However, it is clear that some nurses still lack confidence and skills to perform BLS in an emergency situation. This innovative study included 209 participants, used a mixed methods approach and examined three environments to compare confidence and skills in BLS training. The environments were non- immersive (basic skills room), immersive, (the immersive room with video technology), and the Octave (mixed reality facility). The skills were measured using a Laerdal training manikin (QCPR manikin), with data recorded on a wireless Laerdal Simpad, and the pre and post confidence levels were measured using a questionnaire. The non-immersive and the immersive room rooms were familiar environments and the students felt more comfortable and relaxed and thus more confident. The Octave offered the higher level of simulation utilizing Virtual Reality (VR) technology. Students felt less comfortable and less confident in the Octave; we assert that this was because the environment was unfamiliar. The study identified that placing students in an unfamiliar environment influences the confidence and skills associated with BLS; this could be used as a way of preparing students / nurses with the necessary emotional resilience to cope in stressful situations.
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Tests of clinical competence, which allow decisions to be made about medical qualification and fitness to practise, must be designed with respect to key issues including blueprinting, validity, reliability, and standard setting, as well as clarity about their formative or summative function. Multiple choice questions, essays, and oral examinations could be used to test factual recall and applied knowledge, but more sophisticated methods are needed to assess clincial performance, including directly observed long and short cases, objective structured clinical examinations, and the use of standardised patients. The goal of assessment in medical education remains the development of reliable measurements of student performance which, as well as having predictive value for subsequent clinical competence, also have a formative, educational role.
Article
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Introduction: Regular assessments are recommended to identify individuals requiring additional resuscitation training. We developed a strategy of short CPR self-learning sessions followed by automated assessment with feedback and investigated its efficiency to achieve a pre-defined level of compression skills. Methods: Four hundred and four students in pharmacy and educational sciences participated. Initial training (max. 40 min) consisted of a 15 min learning-while-watching video followed by manikin exercises with computer voice feedback. At baseline and after training, performance was measured using an automated test. To be judged competent participants had to achieve ≥ 70% compressions with depth ≥ 50 mm and ≥ 70% compressions with complete release (<5mm) and a compression rate between 100 and 120 min(-1) within a two month period. Automated feedback was provided and failed participants had to retrain within two weeks. Retraining (max. 20 min and max. three times) was done with voice feedback exercises. Before retraining, the previous test result was displayed together with feedforward. After five months all participants were invited for a retention test. Results: After one to four sessions, 99% (401/404) of all participants achieved competency. After five months 48% (137/288) of the students participating in the retention test was still competent. The percentage competent participants was 80% (230/288) for compression depth, 97% (279/288) for complete release and 60% (172/288) for mean rate. Conclusions: One or multiple short self-learning sessions were highly efficient to successfully train 99% of participants. After five months, retention of compression depth and complete release was very high. However, only 48% still achieved a 70% combined score for compression skills, highlighting the importance of regular assessment and retraining.
Article
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The objective of the study was to evaluate a device that supports professionals during neonatal cardiopulmonary resuscitation (CPR). The device features a box that generates an audio-prompted rate guidance (feed forward) for inflations and compressions, and a transparent foil that is placed over the chest with marks for inter nipple line and sternum with LED's incorporated in the foil indicating the exerted force (feedback). Ten pairs (nurse/doctor) performed CPR on a newborn resuscitation mannequin. All pairs initially performed two sessions. Thereafter two sessions were performed in similar way, after randomization in 5 pairs that used the device and 5 pairs that performed CPR without the device (controls). A rhythm score was calculated based on the number of CPR cycles that were performed correctly. The rhythm score with the device improved from 85 ± 14 to 99 ± 2% (P < 0.05). In the control group no differences were observed. The recorded pressures with the device increased from 3.1 ± 1.6 to 4.9 ± 0.8 arbitrary units (P < 0.05). The second performance of the teams showed significant better results for the group with the CPR device compared to the controls. Feed forward and feedback signaling leads to a more constant rhythm and chest compression pressure during CPR.
Article
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Current methods to assess Basic Life Support skills (BLS; chest compressions and ventilations) require the presence of an instructor. This is time-consuming and comports instructor bias. Since BLS skills testing is a routine activity, it is potentially suitable for automation. We developed a fully automated BLS testing station without instructor by using innovative software linked to a training manikin. The goal of our study was to investigate the feasibility of adequate testing (effectiveness) within the shortest period of time (efficiency). As part of a randomised controlled trial investigating different compression depth training strategies, 184 medicine students received an individual appointment for a retention test six months after training. An interactive FlashTM (Adobe Systems Inc., USA) user interface was developed, to guide the students through the testing procedure after login, while Skills StationTM software (Laerdal Medical, Norway) automatically recorded compressions and ventilations and their duration ("time on task"). In a subgroup of 29 students the room entrance and exit time was registered to assess efficiency. To obtain a qualitative insight of the effectiveness, student's perceptions about the instructional organisation and about the usability of the fully automated testing station were surveyed. During testing there was incomplete data registration in two students and one student performed compressions only. The average time on task for the remaining 181 students was three minutes (SD 0.5). In the subgroup, the average overall time spent in the testing station was 7.5 minutes (SD 1.4). Mean scores were 5.3/6 (SD 0.5, range 4.0-6.0) for instructional organisation and 5.0/6 (SD 0.61, range 3.1-6.0) for usability. Students highly appreciated the automated testing procedure. Our automated testing station was an effective and efficient method to assess BLS skills in medicine students. Instructional organisation and usability were judged to be very good. This method enables future formative assessment and certification procedures to be carried out without instructor involvement. B67020097543.
Book
This unique and ground-breaking book is the result of 15 years research and synthesises over 800 meta-analyses on the influences on achievement in school-aged students. It builds a story about the power of teachers, feedback, and a model of learning and understanding. The research involves many millions of students and represents the largest ever evidence based research into what actually works in schools to improve learning. Areas covered include the influence of the student, home, school, curricula, teacher, and teaching strategies. A model of teaching and learning is developed based on the notion of visible teaching and visible learning. A major message is that what works best for students is similar to what works best for teachers - an attention to setting challenging learning intentions, being clear about what success means, and an attention to learning strategies for developing conceptual understanding about what teachers and students know and understand. Although the current evidence based fad has turned into a debate about test scores, this book is about using evidence to build and defend a model of teaching and learning. A major contribution is a fascinating benchmark/dashboard for comparing many innovations in teaching and schools.
Article
Background: Australian critical care nurses generally undertake assessment of resuscitation competencies on an annual or biannual basis. International resuscitation evidence and guidelines released in 2010 do not support this practice, instead advocating more frequent retraining. Aim: To review the evidence for annual assessment of resuscitation knowledge and skills, and for the efficacy of resuscitation training practices. Methods: A search of the Medline and CINAHL databases was conducted using the key search words/terms 'resuscitation' 'advanced life support' 'advanced cardiac life support' 'assessment' 'cardiac arrest', 'in-hospital cardiac arrest', 'competence', 'training', 'ALS', 'ACLS' 'course' and 'competency'. The search was limited to English language publications produced during the last 10 years. The International Liaison Committee On Resuscitation worksheets were reviewed for key references, as were the reference lists of articles from the initial search. Results: There is little evidence to support the current practice of annual resuscitation competency assessments. Theoretical knowledge has no correlation with resuscitation performance, and current practical assessment methods are problematic. Both knowledge and skills decline well before the 12-month mark. There is emerging support in the literature for frequent practice sessions using simulation technology. Conclusion: The current practice of annual assessments is not supported by evidence. Emerging evidence for regular resuscitation practice is not conclusive, but it is likely to produce better outcomes. Changing practice in Australia also represents an opportunity to generate data to inform practice further.